Saturday, April 18, 2009

Health Literacy Worse Where There is DTC Advertising than Where There is No DTC!

One of the issues raised at the recent DTC National conference in Washington, DC was the impact of direct-to-consumer (DTC) advertising on health literacy.

Mark Senak -- blogger at EyeOnFDA, who participated in a panel discussion -- raised the ante on DTC's educational merit and suggested that we "Look abroad (where there is no DTC), and measure the health literacy to see the potential impact" (see these tweets).

I did some research and found a report that compared health literacy in the US (where there IS DTC) and in Canada (where there is no DTC advertising). The report, entitled "Health Literacy in Canada," cited research that used the same point system as the US to measure health literacy in Canada and compared it's results to the US data:

"Canadian men outperform their American counterparts by roughly 12 points. Canadian women outperform their American peers by roughly 15 points. These differences are larger than the differences in the underlying cognitive skills such as literacy and numeracy, which raises questions about the underlying causes of the differences and their impact on population health."

This was summed up in the chart on the left.

So much for DTC improving health literacy!

Proponents of DTC advertising often defend it by saying that it is educational. Does this data destroy that argument?

Not necessarily. There is a difference between health literacy and being "educated" about a drug. DTC proponents may need to place an asterik next to "education" in their argument about the utility of DTC so we all understand that they mean the latter and not the former.

How can we accept your conclusion when we know so little about the study your citing or its methodology...It's not clear what was measured in or with whom or whether any of the study participants saw DTC advertising and if so which ones...so it seems premature to make these kind of broad sweeping conclusions?Additionally, if FDA and Pharma want to improve health literacy, they could start by using 'simpler and less' risk and benefit communications in DTC ISI's etc so that consumers would have a chance of understanding and digesting the information. This is something that I believe would go along way to improving health literacy...

You need to go to the original source that I linked to and get the methodology from that -- the important thing is that the methodologies used in CA and the US were the same.

It is not in the FDA's purview to require that pharma improve our health literacy. Only pharma and its supporters claim that DTC is "educational" and Mark Senak brought up the idea that DTC could also improve health literacy, which I tried to disprove here.

Branded DTC is fine for educating consumers that there is a specific treatment for a medical condition. But that is much different goal than improving health literacy, which is something that pharma marketers should not fool themselves into believing is their goal.

How do we know that DTC hasn't improved the health literacy of Americans if we don't compare to levels from before? Perhaps the US has always been behind Canada in health literacy, and DTC has improved it, but not to Canadian levels?

The fact that Canada is ahead of the US further illustrates this point. If DTC had no effect, then the US should be equal to Canada. The fact that they are ahead suggests either DTC is making us more illiterate (a stretch), Canadians are smarter in general (seems to be neutralized by the literacy and numeracy scores), or perhaps Canadians are more well informed by other sources like public health messages or differences in schooling on health subjects. I am inclined to think DTC has little to do with it.

The federal government (e.g. NIH, HHS, et. al) recognize that 90 million or nearly 1/3 of Americans don't know how to read a prescription bottle. If a patient, consumer, caregiver, etc. doesn't know how to read their own doctor's instructions, then there will be poor patient compliance/adherence leading to disease complications.

There's a saying that you can catch more bees with honey than vinegar. The Rx industry would score alot more NRx by producing commercials that help consumers understand how to follow their doctors prescriptions leading to more refills at the pharmacy. Subsequently, consumers will begin to see pharma in a more proactive, prevention, and participatory light which is where the government is trying to steer our healthcare society.

Let's call a duck a duck. DTC advertising was not introduced to educate the public. The reason why big pharma wanted DTC advertising in the first place was because they thought it would bring in higher revenues and profits. Which is totally rationale. Businesses should make decisions that will increase revenues and profits and decrease expenses. However, it is unethical to manipulate people, and I do believe big pharma generates some profits by taking advantage of the lack of health literacy in our country. If big pharma really wanted to educate our population, they would help fund health literacy programs, not prime-time TV commercials or high-gloss ads. Of course, an educated and healthier population might not need as many drugs...

Though we can be embarrassed by our lower score, the Canadian level 2 literacy skills are not worth praise either. That means that 60 percent of their population is considered to be health illiterate. Nevertheless, I wonder if the gap in literacy levels between us and our cousins up north can, to some degree, be explained by Canada's universal health care system.

Canada just provided all citizens with free access to The Cochrane Library for the next 9 months. http://www.ccnc.cochrane.org/en/index.html. This speaks to Canadians' faith that the citizenry (and the healthcare system) will benefit from decisions informed consumers make, access to high-end information being a key component of good decision-making. (It probably reflects "next steps" in the journey that has Canada leading in measures of health literacy thus far.) By the way, I wanted to provide a direct link to what Cochrane says about "Interventions for enhancing medication adherence," to further this discussion but, alas, this is the U.S. and I accessed the hard copy I have through a closed academic portal.

Health literacy should not be left in the hands of Big farma, simply because they have biases, they are trying to sell a product and may even complicate the doctor patient relationship by leading people to think they need to take a certain drug. Big pharma is about persuading people to buy a product that they may or may not need. Health literacy is about equipping patients with skills that they will need to achieve their health goals. Therefore, there needs to be public health organization that are as committed as Big Pharma in getting their message across to the nation.

About the Author

Pharmaguy™ (@pharmaguy) is a "constructive critic" of the pharmaceutical industry. He is not shy about giving his opinion, which is respected by many insiders who share some of his views but who are unable to voice them on their own.